KNOWLEDGE, ATTITUDE AND PRACTICE ON BLOOD DONATION AMONG UNIVERSITY STUDENTS: A SYSTEMATIC REVIEW OF LITERATURE

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1 1 2 Janet Alexis A. De Los Santos*, Carmen N. Firmo 1 Department of Nursing, Visayas State University 2 Department of Nursing, University of the Philippines Manila- School of Health Sciences, Palo, Leyte, Philippines *C orresponding Author s janetalexis.delossantos@vsu.edu.ph ABSTRACT Objective: Students are considered as the best source to mitigate the need for experienced especially among nations on a low resource. This study assessed the knowledge, attitude, and practices of in relation to donation in a developing country. Methods: This study utilized a systematic review of the literature to assess the knowledge, attitude, and practices of on donation. Using the keywords on eight research databases, the search was able to run 53 hits. Full texts, peer-reviewed, quantitative research design, in English language and published within the year were the inclusion criteria observed in the review. Appraisal on methodological quality of literature was done on the gathered studies. There are five (5) studies that were considered appropriate for review. Results: Findings revealed that all literature were conducted from developing countries. Students are knowledgeable and has a good attitude towards donation, however, there is a low turnout on the actual practice and volunteerism in donating. More specifically, inclined to health have better knowledge and attitude compared in non-health related course. Female are found to have low intention to donate. Interventional strategies that are suggested by the literature are mass media and enhancing donor efficiency. Conclusion: Evaluating the results of the previously conducted studies revealed the high knowledge and attitude of in developing countries relative to donation. There is a need to intensify education and advocacy campaigns to translate knowledge and attitude into practice. Keywords: Knowledge, Attitude, Practice, Blood Donation, Students, Developing Country doi: /mjmr v03i KNOWLEDGE, ATTITUDE AND PRACTICE ON BLOOD DONATION AMONG UNIVERSITY STUDENTS: A SYSTEMATIC REVIEW OF LITERATURE INTRODUCTION Blood donation has long been taught of as an act of altruism. From a single donation alone, three components may be derived useful to specific patient needs. A pack of may prolong the lives of patients with loss, leukemia, hemophilia, maternal deliveries, major traumatic injuries and even those who are for transplants. Similarly, donation is considered as a vital measure in emergency preparedness for disaster and an essential component in the efficiency of the health care delivery system. There are certain parameters that must be observed for a person to donate which may include an ideal body weight, pressure, pulse rate; Hemoglobin values of at least 125 gm/dl and most importantly; without existing medical conditions like cancer, cardiac diseases, STDs, lung diseases, or those exposed on high risk occupation among others. The need for is experienced by all countries across the globe but is found to be more of a challenge by most developing countries primarily because of the lack of people who are willing to donate, and the lack of donor system (Shan et al., 2002). Globally, the recruitment of voluntary donors remains as one of the major challenges most especially in developing countries. A common problem is the lack of safe and lowrisk voluntary donor because of some cultural beliefs, lack of knowledge on the benefits of donating as well as the lack of donation advocates (Shan et al., 2002, Sandborg, 2007 ; Viswananthan, 2001). Certain issues on safety come from nonvoluntary donors or those classified as remunerated donors. Generally, it is observed that the non-voluntary donors have lower retention and are found to be carriers of transfusion- transmissible infections (TTIs) including Hepatitis, Malaria, Syphilis and even HIV/AIDS (Strauss, 2001 ; van der Poel, Seifried & Schaasberg, 2002). Furthermore, studies have suggested the link of knowledge and attitude to the success of donation practice including the barriers and motivators which plays a significant role in 18 Vol. 3 (1) JANUARY 2019 Malaysian Journal of Medical Research

2 transforming a person to become a donor. The World Health Organization recommends that must be collected from voluntary non-remunerated donors (VNRD) because it is found to have lower rates of transfusion-transmissible infections making it generally the ideal way to secure safe (World Health Organization, 2010). Likewise, the incidence of misinformation on medical and social history are unlikely among VNRD since their source of motivation is grounded on the premise of giving a gift of life to those in need (World Health Organization, 2010 ; Dubey et al., 2014). To meet the global demand for and products, some studies have considered university as a potential source (Ngoma, 2013). Focusing collection on this age group is for reason that they are considered healthy, active, receptive, and comprise most of the population. They are the healthiest source of safe compared to another age group who may be carriers of TTIs (World Health Organization, 2010, Arsad et al., 2016 & World Health Organization, 2010). In realizing this, it is necessary to investigate the knowledge, attitudes, and practices of this target group which can be used as a basis by the health department especially in low sourced countries in developing more effective strategies to increase the number of voluntary donors from this age-group and sector of the population. METHODOLOGY Aim A systematic literature review was undertaken to examine published articles focusing on the concept of knowledge, attitude, and practices related to donation involving. The key questions guiding the literature review were: 1. What does the literature say about the knowledge of pertaining to donation? 2. What attitude do these have in relation to the act of donating? 3. What is the common practice of donation among these? 4. What other themes exist in the literature? Search Strategy A systematic literature review is appropriate for the diverse range of literature published about the concept of KAP on donation among. The review consisted a comprehensive search in eight research databases including Academic Search Premier, CINAHL, Education Research Complete, ERIC, Psychology and Behavioral Science Collection, Gale, PubMed, and Health Research and Development Information Network (HERDIN). The search utilized the 5-keyword combination namely 'Knowledge', 'Attitude', 'Practice', 'Blood donation', and ''. The search was done May 22-23, Inclusion and exclusion criteria The following are the inclusion and exclusion criteria applied to the identified articles: Inclusion criteria: (1) Completely contains the keywords Knowledge, Attitude, Practice, Blood donation and Students as variables of the study (2) Published within the year (3) In full-text (4) Peer-reviewed (5) Research design utilized is quantitative (6) In the English language Exclusion criteria: (1) Incomplete keywords or lacking variables (2) Published earlier than 2013 (3) Non-full-text (4) Non-peer-reviewed (5) The research design is qualitative (6) Language is not in English Search results The first search resulted in 53 hits. The number reduced to 16 after a reappraisal of titles. Thirty-seven (37) titles and abstract that were outside the years , and not classified as a scholarly journal article were eliminated. All in all, there are five (5) studies that were considered suitable for review upon checking that it is in full-text and in the English language. The process observed to denote pertinent studies for this critical review is shown in the following figure. Malaysian Journal of Medical Research Vol. 3 (1) JANUARY

3 Figure: PRISMA flowchart Appraisal and data synthesis The researchers utilized a checklist to appraise quantitative studies being a popular tool to valuate methodological quality of quantitative papers (Kmet, Lee & Cook, 2004). The instrument comprise 12 items components individually scored between 0-2. Quality appraisal was separately done by two authors using the appraisal checklist which was later consolidated and analyzed. It revealed that the quality score in this review ranges between six (6) to twelve (12) with twelve as the highest possible score. Due to the variety of instruments used and differences in samples used by the studies in the retrieved articles, a meta-analysis of data was not possible. Thematic analysis technique was utilized being the most appropriate technique best fit for this review (Centre for Reviews and Dissemination, 2008). A summary of data extracted from the articles were collated in a table and analyzed manually. The extracted data from studies included the following: author, year, country, number of student respondents, nature of program enrolled by the sample, research design, areas assessed on the KAP questionnaire, key findings on knowledge, attitude, and practices to donation and other relevant findings. RESULTS The findings of this review are presented according to its (1) general characteristics of literature; (2) methodology; (3) knowledge on donation; (4) ' attitude on donation; (5) the actual practice of donation among, and; (5) factors affecting knowledge, attitude and practice on donation; and (6) interventional strategies in enhancing donation practice among (Table). 20 Vol. 3 (1) JANUARY 2019 Malaysian Journal of Medical Research

4 Table: Summary of Literature Authors /Year Research Design Samples/ Respons e Rate Topics assessed on KAP questionnaire Key Findings Other findings Kowsalya et Cross N=371 Knowledge on Practice can al., 2013 sectional Medical the Nature of donation, requirements for be enhanced by improving knowledge, donation, tests and positive carried in attitude on banks, storage, donation among college components,. usage of, benefits to donors; Attitude and Practice on donation; Raghuwans hi et al., 2016 Cross sectional N= 399 Medical and Non - medical Knowledge of donation process, and transfusion, practice of Knowledge varies according to gender, degree program, and parents job, donation, There is no attitude of difference in donors, knowledge intervention based on strategies in residence recruiting status, and voluntary type of family donors structure Voluntary donation is found among nonmedical, Malaysian Journal of Medical Research Vol. 3 (1) JANUARY

5 males, with parents on medical jobs, and belonging in a joint family Gebresilase Cross N=360 Knowledge, Female Oromo et al., 2017 sectional comparative Medical and Non - medical attitude, practice level were more likely to have better knowledge than male Ethnicity has more favorable attitude to donation compared Health science have better attitude compared to non -health related. to with Amhara background. Female non - health science were more likely to donate and has favorable attitude than male non. The higher the academic year of the student in non - health related course, the more likely are they to practice donate, however in lower 22 Vol. 3 (1) JANUARY 2019 Malaysian Journal of Medical Research

6 years have more desirable attitudes. Chopra and Cross N-278 Awareness and Medically Mass Jauhari 2015 sectional Medical knowledge on frequency of donation, cause and willingness for donation, attitude and practice of donation inclined have high knowledge in donation, but there is low in actual practice because of the lack of opportunities to donate. media/ Academics enhances knowledge on donation. Males have higher participation in donation because they are more associated with outdoor activities, decision making or getting more opportunity. Tadesse et Cross N= 351 Knowledge on Knowledge on Midwifery al., 2018 sectional Health Science voluntary donation benefits, risks, eligibility criteria; donation is related to the year level, program have more favorable attitude, enrolled, and attitude practices, exposure to toward mass media, Malaysian Journal of Medical Research Vol. 3 (1) JANUARY

7 associated factors Students who have less knowledge are less likely to have favorable attitude towards voluntary donation. donation compared to nursing. General characteristics of the literature Meticulous selection and evaluation of articles were done on the remaining works of literature after screening. The literature included were conducted from developing countries which highly relates to the characteristic of the intended recipient of the results of this review. The articles were published from Pakistan Journal of Biological Sciences (2013); Indian Journal of Community Health (2015); Journal of Clinical and Diagnostic Research (2016); BioMed Central (2017) and I Med Pub (2018). Most studies were conducted in India (Kowsalya et al., 2013; Raghuwanshi, Pehlajani, & Sinha, 2016 ; Chopra, & Jauhari, 2015) and the remainder originated from Ethiopia (Gebresilase, Fite & Abeya, 2017 ; Tedesse et al., 2018). METHODOLOGY The literature utilized survey approach in a crosssectional research design and involved whose degree program relates to health, where two from this (Raghuwanshi, Pehlajani & Sinha, 2016 ; Gebresilase, Fite & Abeya, 2017) compared the group to a nonhealth related set of. Sample size ranged between The studies employed the use of a questionnaire as a means of gathering the needed data on knowledge, attitude, and practice (KAP) on donation. More specifically, Nature on donation, screening tests in banks, components, eligibility requirements for donors, usage of and benefits to donors were variables assessed in the study of Kowsalya et al., (2013) and Tedesse et al., (2018). Variables on the donation process, transfusion, intervention strategies in recruiting voluntary donors were included in the study of Raghuwanshi, Pehlajani & Sinha (2016). Aside from KAP Chopra and Jauhari (2015) included the variables frequency of donation as well as the different causes and willingness for donation. There were three (3) studies (Raghuwanshi, Pehlajani & Sinha, 2016; Chopra & Jauhari, 2015 ; Tedesse et al., 2018) who discussed their ethical procedure which was done by seeking ethical clearance from an institutional review board. Knowledge on Blood Donation The studies assessed basic knowledge of and products, donation process, and eligibility requirements for donors (Kowsalya et al., 2013; Raghuwanshi, Pehlajani & Sinha, 2016; Tedesse et al., 2018). Three from the five available literature discussed that have high awareness based on the high scores observed in their overall score in knowledge (Kowsalya et al., 2013, Raghuwanshi, Pehlajani & Sinha, 2016 ; Tedesse et al., 2018). The study of Gebresilase, Fite & Abeya (2017), however, presented the difference in knowledge between healthrelated from non-health where knowledge favors the former. Chopra & Jauhari (2015), more specifically discussed the age requirement and frequency as their measures of knowledge on donation. Kowsalya et al., (2013) found that most are knowledgeable on the suitable age requirement for donation, followed by the knowledge on ideal pressure, health benefits of donating to donor, weight requirement, screening tests, amount of extracted per session, components, number of lives saved in one pack of donated, and lastly, the maximum storage days of each donated. Tedesse et al., (2018) elaborated on the measures for knowledge items. Based on the study it revealed that the are knowledgeable in terms of types of ; the potential transfer of disease from an infected ; human being not artificially made; 24 Vol. 3 (1) JANUARY 2019 Malaysian Journal of Medical Research

8 sources of for donation; groups considered as ineligible for donation which may include: smokers, with multiple sexual partners, on chronic alcoholism, HIV infected, diagnosed with low or high pressure, persons with maintenance medications, allergies and fever. The Attitude on Blood Donation The literature gathered revealed that health-related have a more positive attitude on donation compared to in non-paramedical degrees (Kowsalya, 2013; Raghuwanshi, Pehlajani & Sinha, 2016; Chopra & Jauhari, 2015; Gebresilase, Fite & Abeya, 2017 & Tedesse et al., 2018). Based on the gathered attitude statements from the literature, there are two classifications that can be made positive and negative responses. Literature revealed that among paramedical, both positive and negative attitudes are present (Kowsalya, 2013). Among positive attitudes were the lack of request from these to become donors. The claimed that no one ever asked them to become advocates. For some few donors, they believe voluntarily donating is a good habit and act of practicing their social responsibilities. Another is the unawareness of donating stations, or the lack of time and opportunity to join in caravans. Majority of the answered that they will encourage other people to become donors. They affirm that the source of is from the voluntary non-remunerated donors. In worst case scenarios, the are also willing to donate when needed especially in times of emergency situations (Raghuwanshi, Pehlajani & Sinha, 2016). Remarkably, most of the in both groups answered that they will not receive any payment for donating. The satisfaction of being able to extend aid to others is enough reason to extend help (Kowsalya, 2016; Chopra & Jauhari, 2015 & Gebresilase, Fite & Abeya, 2017). Most will donate because they believe it has no significant effect to them as donors, while at the same time being able to help friends, relatives, and even unknown people who are in need (Chopra & Jauhari, 2015). Some consider earning a certificate as a small incentive for donating is a rewarding experience. However, more than half of this feel they still need their parents' permission prior to donating, perhaps they feel the decision is not theirs alone but rather require approval from their parents (Kowsalya, 2016; Tedesse et al., 2018). Among the negative attitudes observed, the selfperception of being medically unfit scored highest, followed by the perceived anemic-effects of donation, the chances of getting harmed or infected, perception on how donation lowers immunity, the lack of interest to donate, fear of bodily weakness, fear of the procedure, the need for monetary compensation. Some in the non-medical field feel that being a paid donor is acceptable (Raghuwanshi, Pehlajani & Sinha, 2016; Chopra & Jauhari, 2015 ; Tedesse et al., 2018). Practice on Blood Donation among Students The practice of donation is low and is nonvoluntary among regardless of whether they are pursuing a health-related degree program or not, except for the one study India where more than half have experienced donating (Kowsalya, 2013; Raghuwanshi, Pehlajani & Sinha, 2016; Chopra & Jauhari, 2015; Gebresilase, Fite & Abeya, 2017 & Tedesse et al., 2018).Tedesse et.al (2018) found in their study that medical reason was found to be the most common reason for not being regular donor among. The same author found that the lack of information and fear of weakness and parental restriction are other major reasons deterring regular donation. Furthermore, the same study found that among donors, helping friends and family, altruism, and social responsibilities are the main reason for donating. Students also responded that lack of being requested to donate, the long waiting time, and discomfort after donation is among the reasons why they don't consider being regular donors (Kowsalya, 2013). Factors affecting the knowledge, attitude, and practice of donation among Based on literature, there are several factors that influence the knowledge, attitude, and practice of donation among. Knowledge in donation is affected by gender, degree program, year level, and exposure to mass media information. Female are found to be more knowledgeable compared to Malaysian Journal of Medical Research Vol. 3 (1) JANUARY

9 males (Raghuwanshi, Pehlajani & Sinha, 2016 & Gebresilase Fite & Abeya, 2017).By virtue of their academic exposure, medically inclined or those enrolled in health-related courses have high knowledge (Raghuwanshi, Pehlajani & Sinha, 2016; Chopra & Jauhari, 2015 ; Tedesse et al., 2018).Two works of literature suggests that mass media information contributed to the increase in knowledge on donation (Chopra & Jauhari, 2015 ; Tedesse et al., 2018). Similarly, it is found that being female, enrolled in a health-related course, and has high knowledge generally have a better attitude on donation (Gebresilase, Fite & Abeya, 2017; Tedesse et al., 2018). There are several factors affect the practice on donation. Despite high levels of knowledge, the lack of opportunities to donate was found to be the main reason why there is a low actual voluntary donation practice among. It also revealed that females have high interest to donate but it is the males who do the actual participation of donating (Raghuwanshi, Pehlajani & Sinha, 2016; Chopra & Jauhari, 2015 ; Tedesse et al., 2018). A conflicting result in the study highlighted the inverse relationship of knowledge to practice. It revealed that more non-medical are voluntary donors compared to medically inclined whose parents were also in medical professions (Raghuwanshi, Pehlajani & Sinha, 2016). Interventional Strategies for enhancing donation practice among The need to promote the practice of donation is necessary to strengthen and realize volunteerism as well as increase the collection of safe and healthy. Literature have suggested that promotion is proven to be a successful strategy in increasing awareness and retention of donors. One strategy that may be done is incorporating the concept of donation in school curriculum and the periodic conduct of donation awareness programs. The literature revealed that mass media play a big role in information dissemination (Kowsalya et al., 2013, Chopra & Jauhari, 2015 ; Tedesse et al., 2018). Information from friends and relatives, school, and even from donors themselves are effective in raising awareness to others on the need to become donors. The ease of providing donation camps and transport of to the donation station is recommended for donor efficiency (Raghuwanshi, Pehlajani & Sinha, 2016 ; Chopra & Jauhari, 2015). Likewise, it is also advisable that banks provide a master list of donors described as ' donors diary' to easily locate healthy donors and remind them of their next donation session. DISCUSSION The most important finding that was established on this review is the fact that, regardless of their enrolled degree program, have a varying degree in terms of knowledge and attitude toward donation. Results revealed non-exclusivity of high KAP to donation in favor to whose program or courses are inclined to paramedical nature. It can be established that regardless of exposure, literature suggest that display similar KAP on donation. There is a commonality to all literature reviewed that there is a low practice of donation among this age group and sector in the society. Although may possess good knowledge and attitude toward donation, it does not translate into their actual practice. The literature reveals that undeniably, there is a general lack of KAP among to donation, this is largely perception based, hence cannot be regarded as an objective data. The tools or instruments used by the studies included in this review were based on the selfreport and perception of on donation. This can be an area where researchers can consider and explore predictors for low practice in donation. The worldwide efforts of the WHO to increase voluntary donation among developing countries is still far from its achievement based on the gathered literature. Countries still need to work hard and double its efforts in increasing the participation of these healthy potential donors into an active voluntary role. While it may already be an achievement that awareness as well as attitude among this group is high, a question remains on why despite it all, they remain uninvolved. Researchers need to focus on improving and solving issues hindering the actual practice on donation. Considering the methodology used, it was found that 26 Vol. 3 (1) JANUARY 2019 Malaysian Journal of Medical Research

10 the different tools or instrument used to gather data on knowledge, attitude and practice are measured on different descriptors. The variability of student respondents was also considered. This means that although the in this review have high scores on knowledge and attitude or low in practice it cannot be generalized as the same because of the difference on what constructs and structure were included from the variety of the instruments used. The different constructs used by the different literature nevertheless may be utilized to create a single instrument incorporating all studies on KAP on donation. This way, a more substantive KAP on donation questionnaire may be devised. By gathering and integrating all constructs into one a more meaningful instrument may be created that could provide the best measures of knowledge, attitude and practice among regarding donation. Perhaps if a single tool can capture the entirety of KAP to donation among this sector, more comprehensive and reliable interventions may be done to increase participation of student's vis-a-vis stable supply of ready for use by the community. Furthermore, it can be noted that the reviewed methodologies used by the literature are descriptive in nature. There is a need for a more rigorous approach to determining how to increase student involvement in the practice of actual donation as well as how to resolve factors that hinder their voluntary donation practice. There were two studies who did not expound on the merits of ethical clearance (Kowsalya et al., 2013 ; Gebresilase, Fite & Abeya, 2017). Because the respondents included in their study involves who may also be minors, the need for ethical clearance from an institutional review board or at least an ethics review committee is essential. This omits the possibility of by-passing the right to be informed while ensuring that human rights in relation to serving as respondents of a research study is protected. The included literature observed thorough sampling through power analysis except for one study who failed to discuss the sampling technique done to determine the sample size used (Kowsalya et al., 2013). Similarly, the sample sized used by the literature is small which makes the results dubious to be applicable and transferable to other settings. Though it may be true that transferability is an issue, one thing is for certain based on the commonality of the findings there are high knowledge and attitude but low practice in donation among university. Despite the methodological issues and challenges observed in this review, evidently, there is one common finding. It is recognized that certainly, there is a lack of donors among developing countries most especially among who are considered as one of the best sources of healthy. This review limited only to eight (8) databases namely including Academic Search Premier, CINAHL, Education Research Complete, ERIC, Psychology and Behavioral Science Collection, Gale, PubMed, and Health Research and Development Information Network (HERDIN). Further, the developing countries involved in the review were limited only to what literature was gathered. Therefore, it is recommended to search more literature from other databases which are related to the subject discussed. Another limitation is the exclusion of non-peer reviewed and qualitative literature. There is much information that may be provided that may not have been discussed by the literature included in this review which highlighted only papers in scholarly journals. An integrative review of literature is therefore recommended. CONCLUSION Evaluating the results of the previously conducted studies revealed the high knowledge and attitude of in developing countries relative to donation. However, it cannot be denied that there is low involvement to the practice of donating neither as a voluntary donor. This non-translation in actual donation practice in spite of their desirable knowledge and attitude calls for a deeper investigation and intervention. As a nation classified as a developing country, there is a need to intensify education and conduct of massive advocacy campaigns to increase the number of donors in this sector of the society. ACKNOWLEDGEMENT The authors wish to thank St. Paul University Philippines for granting the access to the research Malaysian Journal of Medical Research Vol. 3 (1) JANUARY

11 database used in this study. REFERENCES Arshad, A., Borhany, M., Anwar, N., Naseer, I., Ansari, R., Boota, S., Fatima, N., Zaidi, M. & Shamsi, T. (2016). Prevalence of Transfusion Transmissible Infections in Blood Donors of Pakistan. BMC Hematology, Pages 6. Centre for Reviews and Dissemination. (2008). Systematic Reviews: CRD's Guidance for UndertakingReviewsinHealthCare.Retrievedfrom:ht tps:// ws.pdf Chopra, D. & Jauhari, N. (2015). Knowledge, Attitude and Practices Toward Voluntary Blood Donation Among Medical Students in Barabanki. Indian Journal of Community Health, 27 (3). Dubey, A., Sonker, A., Chaurasia, R. & Chaudhary, R. (2014). Knowledge, Attitude and Beliefs of People in North India Regarding Blood Donation. Blood Transfusion, 12(Suppl 1), s21 s27. Gebresilase, H., Fite, R.O. & Abeya, S. G. (2017). Knowledge, attitude and practice of towards donation in Arsi university and Adama science technology university: a comparative cross sectional Study. Biomed Central Hematology, Pages 10. Kmet, L.M., Lee, R.C. & Cook, L.S. (2004). Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. Edmonton: Alberta Heritage Foundation for Medical Research, USA Kowsalya, N., Vijayakumar, R., Chidambaram, R., Srikumar, R., Reddy, E., Latha, S., Fathima, I., & Kumar, K. (2013). A Study on Knowledge, Attitude, and Practice Regarding Voluntary Blood Donation Among Medical Students in Pudacherry, India. Pakistan Journal of Biological Sciences. 16 (9), pp Ngoma, A.M., Goto, A., Yamazaki, S., Machida, M., Kanno, T., Nollet, K.E., Otho, H. & Yasumura, S. (2013). Barriers and Motivators to Blood Donation Among University Students in Japan: Development of a Measurement Tool. Vox sanguinis, 105(3), pp Raghuwanshi, B., Pehlajani, N, & Sinha, M. (2016). Voluntary Blood Donation Among Students-A Crosssectional Study on Knowledge and Practice vs. Attitude. Journal of Clinical and Diagnostic Research, 10 (10), EC18-EC22. Sandborg, E. (2000). Getting People to Give Blood. Vox Sanguinis, 78 (Suppl. 2), pp Shan, H., Wang, J., Ren, F., Zhang, Y., Zhao. H., Gao, G., Ji, Y. & Ness, P. (2002). Blood Banking in China. The Lancet, 360(9347), pp Strauss, R.G. (2001). Blood Donations, Safety and Incentives. Transfusion, 41(2), pp Tedesse, W., Ayalew, Y., Yisma, E., Liben, M.L. & Wudu, M. (2018). Knowledge, Attitude, Practice and Associated Factors Toward Voluntary Blood Donation Among Regular Health Science Students of Samara University, Ethiopia. Health Science Journal. 12 (1:542). DOI: / X van der Poel, C.L., Seifried, E. & Schaasberg, W.P. (2002). Paying for Blood Donations: Still a Risk? Vox Sanguinis, 83(4), pp Viswananthan, C. (2001). Are our donors safe? Indian Journal of Pediatrics, 68(1), pp World Health Organization.(2010). Toward 100% Voluntary Blood Donation: A Global Framework for Action. Retrieved from: /pubmed/ World Health Organization.(2010). World donor day: new for the world. Retrieved from: 0/_donor_day_ /en/ 28 Vol. 3 (1) JANUARY 2019 Malaysian Journal of Medical Research